INDONESIA: Country Report on Patient Safety The National Committee on Patient Safety Ministry of Health, Republic of Indonesia
INDONESIA:
Country Report on Patient Safety
The National Committee on Patient SafetyMinistry of Health, Republic of Indonesia
HerkutantoGuru Besar FKUI
• Ketua Komite Nasional Keselamatan Pasien Rumah Sakit, Kementerian Kesehatan Republik Indonesia
• Ketua Konsil Kedokteran, Konsil Kedokteran Indonesia, 2014 -2019
Herkutanto 2012
• Menyelesaikan pendidikan Doktor, Sp. For, dokter, dari UI dan Monash University, Melbourne
• Menyelesaikan pendidikan SH, Master of Laws (LL.M) dari UI dan La Trobe University, Melbourne
THE CHALLENGES IN PATIENT SAFETY
• Magnitude of burden: hugh number of population, isolated wide-spread areas, cultural diversity and beliefs
• Limited healthcare resources: limited infrastructures, limited awareness to patient safety
DISCUSSIONS FOR TODAY
1. National Leaderships on Patient Safety
2. Compliance to the Global and Regional Strategies on Patient Safety
3. Infection Control Programme in Indonesia
4. Our Current Principles in Patient Safety
PencananganGerakan Keselamatan Pasien
Rumah SakitOleh
Menteri Kesehatan
Seminar Nasional Persi21 Agustus 2005
JCC
Adoption of Helsinki Declaration on Patient Safety in AnaesthesiologyBy The Indonesian Association of Anaesthesiology, 2012
Hosted by the Indonesian Hospital Association, 2007
NATIONAL POLICIES ON PATIENT SAFETY
• What we have:– Patient Safety Committee at National Level
• What we donot have:– Integration of scaterred activities of Patient Safety
conducted by various sectors
• Action Plan:– Formulate integrated national policy on quality and
patient safety.
DASAR HUKUM
Hospital Act No. 44 Year 2009
Health Act No. 36 Year 2009
Medical Practice Act No. 29 Year 2004
Ministery of Health Decree No. 1691/MENKES/PER/ VIII/2011 on Patient
Safety
Ministery of Health Decree No. 251/MENKES/SK/VII/2012 on The Committee
on Patient Safety
REGULATORY FRAMEWORK
For Patient Safety
PATIENT SAFETY COMMITEE PROFILE
1. Dr. dr. Sutoto, M.Kes. (Asosiasi Perumahsakitan)
2. dr. Umar Wahid, Sp.P (Pakar Perumahsakitan)
3. dr. Adib Yahya, MARS (Pakar Perumahsakitan)
4. Prof. dr. Laksono Trisnantoro, Ph.D (Pakar Perumahsakitan)
5. Elis Puji Utami, Ns, Skep, M.Kes (Unsur Keperawatan)
6. Dr. Zaenal Abidin, MHKes. (Pakar Kesehatan)
7. DR. drg. Nursanty Andi Sapada (Kementerian Kesehatan)
8. Dr. Heru Ariyadi, MPH (Asosiasi Perumahsakitan)
COMPETENCE STANDARD FOR MEDICAL PRACTITIONER IN INDONESIA
CORE COMPETENCE:
• Ability to perform clinical procedures related to the health problem by applying principles of patient safety, personal safety, and the safety of others
Indonesian Medical Council Regulation No. 11 Year 2012On The Competence Standard for Medical Practitioners
INDONESIAN PATIENT SAFETY STRATEGY
MACROLEVEL
MESOLEVEL
MICROLEVEL
National Capacity Building
Institutional Capacity Building
Professional Capacity Building
Rules & Regulations
Advocating Body
Policies & Procedures
Access to resources
Workshop & Training
consultation
IMP
LEM
ENTA
TIO
N
OF
PATI
ENT
SA
FETY
IMPLEMENTING PATIENT SAFETY IN INDONESIA
• All level of Regulators
• Accreditation body
MACROLEVEL
• HospitalsMESOLEVEL
• Health Professionals
• Hospital Managers /Owners
MICROLEVEL
National Capacity Building
Institutional Capacity
Professional Capacity building
FOCUS ACTIVITIES
Professional Empowerment
Regulations
Monitoring
Evaluation
Training Material Development
Regulatory Draft
IT on Reporting System
COMPLIANCE TO THE GLOBAL AND REGIONAL STRATEGIES ON PATIENT SAFETY
WHO
WHO SEARO
EUROPEAN COMMUNITY
2
WHO SEARO:The Strategic objectives of the patient safety
• Strategic Objective 1: Improve the structural systems to support quality and efficiency of health care and place patient safety at the core at all levels of healthcare.
• Strategic Objective 2: Assess the nature and scale of harm to patients and establishsystem of reporting and learning at national level.
• Strategic Objective 3: Ensure a competent and capable work force which is aware and sensitive to patient safety.
• Strategic Objective 4: Prevent and control healthcare associated infection.
• Strategic Objective 5: Improve implementation of Global patient safety challengesandstrengthen patient safety in all health programmes.
• Strategic Objective 6: Strengthen capacity for research and promote patient safetyresearch.
Accreditation mechanism for hospital, laboratory and diagnostic facilities
• What we have:– National accrediting body existed since 25 years ago and has been undergone
ISQua accreditation survey – Hospital accreditation system adapted JCI (Joint Commission International)
standard– Accreditation programme is mandatory for all hospital
• What we donot have:– Health inspectorate for quality is not yet established
• Action Plan:– Accreditation system will be improved with the involvement of the
stakeholders– Health inspectorate for quality
ensure a competent and capable work force which is aware and sensitive to patient safety
• What we have:– The Implementation of Curricullum on Patient Safety for 18 Medical
Faculty since 2011 accroding to the WHO Standard
• What we donot have:– Curricullum on Patient Safety for other healthcare professional
education– Integration with the National Strategy of Patient Safety
• Action Plan:– Developing Curricullum on Patient Safety for other healthcare
professional education– Integration with the National Strategy of Patient Safety
INTEGRATION OF PATIENT SAFETY IN THE MEDICAL EDUCATION CURRICULLUM
• Funded by The Ministry of Education and Culture
• Implemented to 18 School of Medicine in Indonesia since 2011
the nature and scale of adverse events in healthcare system of reporting and learning
• What we have:– On going web based national reporting system for hospitals– Some hospitals implement incident reporting system
• What we donot have:– Integrated national reporting system, feedback, dan learning– national reporting system policies
• Action Plan:– Developing Integrated national reporting system,
feedback, dan learning
Safe surgical care, Safe chid birth, Safe injection, Safe medicine, Safe blood safety
• What we have:– National policy on Safe surgical care, Safe chid birth, Safe
injection, Safe medicine, Safe blood safety
– implementation of Surgical checklist on some tertiary HCF
• What we donot have:– implementation of Surgical checklist on all level of HCF
• Action Plan:– To improve and disseminate surgical checklist
INCIDENT
ACCIDENT
Tindakan Medis
Tindakan Medis
Tindakan Medis
Tindakan Medis
Clinical Privileges
Clinical Privileges
Clinical Privileges
Clinical Privileges
• Professional Misconduct
• Pengaduan
• Kejadian Tak diharapkan
• Pasien Cedera
• KKI
• MKDKI
• Komite Medis
• SubkomiteDisiplin
Clinical Governance
Clinical Governance
Professional isme
Professional isme
Kompetensi& Perilaku
Kompetensi& Perilaku
Keselamatan
Pasien
Keselamatan
Pasien
UU No. 29/2004PRAKTIK KEDOKTERAN
PMK No. 755/2011KOMITE MEDIS
GOVERNING BOARD
Corporate Leadership Clinical Leadership
HOSPITAL MANAGEMENT
CORPORATE CULTUREMEDICAL
COMMITTEE
Corporate Governance SAFETY CULTURE Clinical Governance
Service Excellence Clinical Excellence
PATIENT SAFETY
Herkutanto, 2012
2002 - 2007 : initiation of ICP by the MOH
2007 – 2010 : National Guidelines (MOH Decree) – Technical Guidelines on ICP, Surveilance on HAI (Revised 3 times), Hospital accreditaion instruments
2009: National Working Group on ICP
2009 – 2014: appointment of 10 Hospitals as model for the ICP
MILESTONES OF ICP in INDONESIA
Infection Control Program (ICP) in Indonesia by The MoH
Achievements:
• Dissemination of information re: ICP to 733 hospitals
• 95 ICP Trainers (72 hospital was trained)
• Host of APEC meeting in ICP (2013)
OUR CURRENT KEY PRINCIPLES IN PATIENT SAFETY
AFTER NINE YEARS OF JOURNEY .....
WHAT DO WE NOW BELIEVE ....
4
KEY PRINCIPLES TO PATIENT SAFETY
Key 1: Credat Emptor
• screening and maintaining credibility
• overseeing professionalism
Key 2: Openess
• security and protection to provider
• reporting system and feedback
Key 3: Changes
• cultural & behavior
• risk management strategy
• System Capability• Interface Design • Stress & Workload• Complexity • Automatication
Individual Factors
• Goals & Objectives
• Preconceptions (Expectations)
• Abilities • Experience • Training
Information Processing Mechanisms
Automaticity Long Term Memory Stores
Task/System Factors
State of the Environment
Feedback
Comprehen sion of Current SituationLevel 2
Perception of Elements in Current SituationLevel 1
Projection of Future Status
Level 3
Performance of Actions
Clinical Decision
SITUATION AWARENESS
3 levels of medical error
ERROR IN SITUATION AWARENESS
IMPLEMENTING PATIENT SAFETY IN HOSPITALSP
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POLITICAL WILL, COMMITMENT, & NATIONAL SUPPORT ON PS
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Herkutanto, KKPRS, 2012
MUNICIPAL GOVERNMENT
(Municipal) House of Representatives
PATIENT SAFETY
COMMTTEE
GOVERNMENTSNGO + Others
STANDARDSGUIDELINESSupportingactivities
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CONCLUSION
• Although patient safety activities were not new in Indonesia, we are not perfect yet
• We are struggling to challenge the huge obstacles to comply with the global standard of patient safety